Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. The Adverse Experience Committee; and the Multicenter Diltiazem Postinfarction Research Group
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The Multicenter Diltiazem Postinfarction Trial (MDPIT) reported no consistent diltiazem effect on new or worsened congestive heart failure (CHF) during 12-52 months' follow-up after acute myocardial infarction. This was puzzling in light of the observation that patients with findings suggesting left ventricular dysfunction (LVD) at baseline on diltiazem had more cardiac events (cardiac mortality or recurrent nonfatal infarction) than such patients on placebo. We hypothesized that diltiazem increased the frequency of late CHF as well as of cardiac events, but only in patients predisposed by LVD. Using the same characterizing variables as the primary MDPIT analysis, we found that patients with pulmonary congestion, anterolateral Q wave infarction, or reduced ejection fraction (EF) at baseline were more likely to have CHF during follow-up than those without these markers of LVD. CHF was particularly frequent in the patients with LVD who were randomized to diltiazem. Among those with a baseline EF of less than 0.40, late CHF appeared in 12% (39/326) receiving placebo and 21% (61/297) receiving diltiazem (p = 0.004). Life table analysis in patients with an EF of less than 0.40 confirmed more frequent late CHF in those taking diltiazem (p = 0.0017). In addition, the diltiazem-associated rise in the frequency of late CHF was progressively greater with increasingly severe decrements in baseline EF. This diltiazem effect was absent in patients with pulmonary congestion at baseline but an EF of 0.40 or more, suggesting a unique association between diltiazem-related late CHF and systolic LVD.(ABSTRACT TRUNCATED AT 250 WORDS)
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Diltiazem and verapamil can have negative inotropic effects in patients with LVEF < 40%.
“as diltiazem and verapamil can have negative inotropic effects in patients with LVEF < 40%.222,534,535”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [535]
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- Authors
- Goldstein, R. E., Boccuzzi, S. J., Cruess, D., & Nattel, S.
- Affiliations
- Uniformed Services University of the Health Sciences (US)
- Venue
- Circulation
- Published
- 1991-01
- Volume
- 83
- Issue
- 1
- Pages
- 52-60
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2090674352
- Cited by
- 521
- References
- 0
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 14 · 2023: 16 · 2022: 16 · 2021: 7 · 2020: 24 · 2019: 13 · 2018: 15 · 2017: 17 · 2016: 15 · 2015: 17 · 2014: 4 · 2013: 16 · 2012: 11
- FWCI
- 17.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Henry M. Jackson Foundation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Keywords
- diltiazem, congestive heart failure, myocardial infarction, left ventricular dysfunction, ejection fraction, calcium channel blockers, pulmonary congestion, adverse drug reactions
- MeSH terms
- Diltiazem, Double-Blind Method, Follow-Up Studies, Heart Failure, Humans, Myocardial Infarction, Stroke Volume, Life Tables, Ventricular Function, Left
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